A qualitative study exploring facilitators for improved health behaviors and health behavior programs: mental health service users' perspectives.

OBJECTIVE: Mental health service users experience high rates of cardiometabolic disorders and have a 20-25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop. METHODS: A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. RESULTS: Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

Healthy living? By whose standards? Engaging mental health service recipients to understand their perspectives of, and barriers to, healthy living.

OBJECTIVE: It is well recognized that mental health service recipients experience high rates of cardiometabolic disorders, have poorer diets, and exercise less than the general population. This study sought to explore the meaning of a healthy lifestyle for this population and the barriers they experience to healthy living. METHOD: Focus groups were conducted with 23 individuals who experience serious mental health issues. The meaning of a healthy lifestyle and the barriers participants experience to living healthily were explored. RESULTS: Participants perceived a healthy lifestyle in broader terms than professional guidelines for exercise and diet. A broad framework including friendship, affordable safe housing, employment, spiritual, and emotional good health, as well as healthy eating and exercise, is described. Barriers identified by participants were poor mental and physical health and stigma (structural, social, and self). An unexpected result was the group problem solving that occurred during the focus groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Health care professionals need to understand mental health service recipients' perspectives of a "healthy lifestyle." An understanding of barriers within this context is required, as only then will we be able to empathize and assist as health care professionals. This study also shows that realistic, innovative, and pragmatic solutions occur when mental health service recipients are empowered.